Objective: To assess the impact of the terrorist attack (9.11.01) on mothers’ and children’s stress and coping. Design: Telephone survey of participants enrolled in an prospective, randomized longitudinal, trial testing an interventions to reduce children’s television viewing time and examine its impact on children’s health behaviors. Population: Mothers from 40 middle and low-income families from California participated-48% Caucasian, 30% Hispanic, 14% bi-racial, 6% Asian, and 3% African American. (17 boys /23 girls, M age of 8.7). Concepts: The study examined the role of family functioning, stress, coping and media on post-attack responses. Methods: Previous to the attack data had been gathered on the family demographics and functioning. Both pre and post event data was available for maternal stress and the child’s coping. Media Coverage Telephone Survey: A brief telephone survey within 2 week of the event, asked about family television watching patterns, distress symptoms, and the impact of the event on their immediate family. Statements by mothers during the conversation were noted verbatim and transcribed. Family Demographics (FD) is 31-item parent questionnaire includes items on parents' and child's age, race/ethnicity, parental occupations, income, educational level, etc. Family Assessment Device (FAD) is a 60-item self-report instrument that operationalizes six family domains (problem solving, communication, roles, affective involvement, affective responsiveness, and behavior control). Lower scores denote healthier functioning. Perceived Stress Scale (PSS) is a 14-item measure of the degree to which situations in one's life are appraised as stressful, and more specifically, unpredictable, uncontrollable, and overloading. The PSS has adequate internal and test-retest reliability and is correlated in the expected manner with a range of self-report and behavioral criteria. High scores reflect increased levels of stress. Schoolagers Coping Strategies Inventory (SCSI) is a 26-item self-report instrument that measures children's perceptions of their use of coping strategies. Each coping strategy is rated by the child on how often it was used (frequency) and how much it helped (effectiveness) on a scale of 0 to 3. High scores reflect a greater repertoire and greater effectiveness of coping strategies. Findings: Post attack 68% of mothers and 38% of children reported one or more distressing symptoms. Specific maternal symptoms were: 32% anxiety or depression, 25% difficulty sleeping/ lethargy, 25% difficulty concentrating, 22.5% changes in appetite, and 12.5% irritability. Symptomatic mothers reported higher scores in baseline measures of family functioning: communication (t=-2.43, p=. 02), affective responsiveness (t=-2.72, p=. 01), behavior control (t=-2.74, p=. 01), general functioning (t=-2.71, p=. 01); and preexisting stress (t=-2.74, p=. 01) than those who had no symptom. Post attack these mothers had higher stress scores (t=-3.20, p=. 003) than those without. The frequencies of child’s symptoms were: 17.5% separation anxiety, 12.5% nightmares/ sleep disturbances, 5 aggressive behavior, 5% withdrawn, and 2.5% bed-wetting. Symptomatic children came from families with poorer scores in communication (t=-2.31, p=. 03), roles (t=-2.61, p=. 01), affective involvement (-2.37, p=. 02), and parental stress (t=-2.12, p=. 04). There was a significant lower score in the SCSI effectiveness subscale post attack than pre-attack (t=3.00, p=. 005). Intentional increased television viewing was reported by 64% of mothers but only 8% of children. These mothers had higher pre-attack of poorer problem solving (t=2.15, p=. 04), communication (t=2.59, p .01), roles (t=3.61, p=. 001), affective involvement (t=2.85, p=. 01), general family function (t=2.25, p.04); and stress (t=2.41, p=. 02) than those with no symptoms. Children whose mothers watched more TV, also had higher incidence of symptoms than those whose mothers did not change their TV viewing time (chi-square=5.39, p=. 02). The qualitative content analysis on the impact of the attack revealed three major themes: concern about other family members or friends, concern over economic/financial impact of the attack, and social and environmental concerns. Conclusions: Despite the geographical distance from the attack site, families experienced stress and concern over the event. These finding suggest that both children and mothers were adversely effected by the media coverage, albeit differentially. It is important to note that children with symptoms, despite not changing their own media habits, came from households where mothers did. It is possible that this, and the previous poorer family functioning, and stress in these households lead to the children’s distress symptoms. Despite a rapid public dissemination of advice regarding how to help children cope with the attack, approximately 1/3 manifested distress above community sample baselines. Implications: Healthy responses to crisis are important. Identification of coping strategies that work for both the parent and the child as a family unit is critical. Assessment and evaluation of the role media plays in families emotional responses should be included in comprehensive approaches.
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